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"etiology": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Как правило, вывих бедра возникает в результате значительного высокоскоростного приложения травмирующей силы. Причиной повреждения становятся дорожно-транспортные происшествия, падения с высоты, стихийные бедствия и несчастные случаи на производстве.</span></p>",
"pathogenesis": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Вывихи бедра происходят в результате непрямой травмы. При этом бедренная кость выступает в роли рычага, воздействующего на область тазобедренного сустава. В результате интенсивного воздействия головка бедренной кости разрывает капсулу сустава, повреждает связки и выходит из суставной впадины. Причиной заднего вывиха бедра обычно становится автодорожная травма. Механизм травматического воздействия – резкое вращение или сгибание повернутой кнутри, приведенной и согнутой ноги. Передний вывих бедра чаще возникает при падении с высоты на повернутую кнаружи, отведенную и согнутую ногу.</span></p>",
"diagnostics": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагностика вывихов бедра, как правило, не вызывает затруднений у врача-травматолога. Для уточнения положения головки бедренной кости и исключения возможных костных повреждений проводится рентгенологическое исследование в двух проекциях или МРТ тазобедренного сустава.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение заключается в срочном вправлении и непродолжительной фиксации, за которой следует обязательная функциональная терапия (физиопроцедуры и лечебная гимнастика). Травматический вывих бедра сопровождается рефлекторным сокращением мощных мышц бедра и ягодичной области. Для успешного вправления необходимо эффективно расслабить эти мышцы, поэтому вправление вывиха бедра производится в условиях стационара под общим наркозом с применением миорелаксантов.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При вправлении свежих передненижних, задненижних и задневерних вывихов бедра используется способ Джанелидзе, при вправлении застарелых и свежих передневерхних вывихов – способ Кохера. При передневерхних вывихах бедра способ Джанелидзе не применяется, поскольку существует опасность в процессе вправления сломать шейку бедренной кости. После вправления накладывается скелетное вытяжение сроком на 3-4 недели. Затем пациенту рекомендуют ходить на костылях в течение 10 недель, назначают физиотерапию и лечебную гимнастику.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Повреждение хряща головки бедренной кости при вывихе бедра часто приводит к развитию деформирующего артроза тазобедренного сустава (коксартроза) в отдаленном периоде. В таких случаях при выраженном развитии нарушений в суставе может потребоваться эндопротезирование тазобедренного сустава - его удаление и установка протеза.</span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Специфической профилактики не существует, поскольку чаще всего вывих бедра происходит в результате несчастных случаев. Поэтому важно быть осторожным и не подвергать себя необдуманным рискам.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пациент предъявляет жалобы на резкую боль в области тазобедренного сустава. Для всех видов вывихов бедра характерно вынужденное положение конечности, деформация тазобедренного сустава, более или менее выраженное укорочение конечности на стороне повреждения. Пассивные движения в тазобедренном суставе болезненны, резко ограничены, сопровождаются пружинящим сопротивлением. Активные движения невозможны.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Вынужденное положение конечности определяется расположением головки бедренной кости по отношению к вертлужной впадине. При задних вывихах нога пациента приведена, согнута и повернута коленом внутрь. При задненижнем вывихе бедра деформация тазобедренного сустава выражена больше, чем при задневерхнем. При переднем вывихе конечность пациента развернута кнаружи, отведена в сторону, согнута в тазобедренном и коленном суставах. Передненижний вывих сопровождается более выраженным сгибанием и отведением ноги.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При задневерхнем вывихе бедра головка бедренной кости пальпируется под мышцами ягодиц, при задненижнем – рядом с седалищной костью. Для передневерхнего вывиха характерно уплощение ягодичной области. Головка бедренной кости пальпируется в области паховой складки, кнаружи от бедренной артерии. Передненижний вывих также сопровождается уплощением области ягодицы. Головка прощупывается кнутри от бедренной артерии.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Вывихи бедра могут сопровождаться отрывом края вертлужной впадины и повреждением хряща головки бедренной кости. При задненижних вывихах бедра нередко наблюдается ушиб седалищного нерва. При передних вывихах бедра возможно сдавление бедренных сосудов, при передненижних – повреждение запирательного нерва.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Несвежие и застарелые вывихи бедра сопровождаются менее выраженной клинической симптоматикой. Боли в области сустава со временем уменьшаются. Укорочение и деформация конечности компенсируются за счет наклона таза и резкого увеличения лордоза (поясничного изгиба) позвоночника.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
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"description": "Перелома бедра – это тяжелая травма опорно-двигательного аппарата, в результате которой нарушается анатомическая целостность кости, происходящая из-за воздействия на непрямого удара, падения или полученная в результате скручивания, сгибания.",
"etiology": "<p>В молодом или среднем возрасте обычно случаются переломы верхней части кости из-за падения с высоты или ДТП. Травмирование бедра у пожилых людей случаются в результате прямого удара или падения на область сустава. Переломы шейки бедра может произойти в результате простого спотыкания. Причинами также служат спортивные или производственные травмы.</p>\r\n<p>Механизм перелома у ребенка такой же, как у взрослого человека. Травма случается тоже из-за падения с высоты, перегиба или насильственного скручивания конечности или в результате ДТП. Если в кости развивается патологический процесс, может случиться патологический перелом, возникающий при незначительной травме.</p>\r\n<p>Группа повышенного риска:</p>\r\n<ul>\r\n<li>Самые податливые к травме бедра женщины в пожилом возрасте (каждый 4 случай), это связано с анатомической особенностью кости, которая в некоторых участках тоньше, чем у мужчин. Так же, с наступлением менопаузы, на фоне резкого изменения гормонального баланса, у женщины активно вымывается кальций, и кости становятся хрупкими.</li>\r\n<li>Наличие в анамнезе сахарного диабета, артрита, остеопороза, рассеянного склероза и т.д.</li>\r\n<li>Слепые и плохо зрячие.</li>\r\n<li>Генетическая предрасположенность к костным патологиям.</li>\r\n<li>Люди, проходящие лечение диуретиками и антикоагулянтами.</li>\r\n<li>Алкоголики и наркоманы.</li>\r\n</ul>",
"pathogenesis": "<p>Под влиянием внешней силы, не превышающей пределов ее упругости, кость кратковременно деформируется и снова принимает свою первоначальную форму. Если же воздействующая внешняя сила превышает этот предел, целость кости нарушается. Давление на губчатую кость в продольном направлении вызывает ее сплющивание, при этом образуются компрессионные и вколоченные переломы (позвоночник). При действии скручивающей силы возникают винтообразные или спиральные. Дырчатые переломы - огнестрельные ранения.Переломы в зависимости от направления линии перелома к оси кости: поперечные; продольные; винтообразные; косые.</p>\r\n<p>Ряд переломов, возникающих при сходном механизме повреждения, имеющих одну и ту же морфологическую картину, называют типичными или классическими (перелом лучевой кости в типичном месте, перелом таза Мальгеня).</p>\r\n<p>Патологические переломы возникают самопроизвольно под влиянием незначительной травмы (или даже без всякой травмы) кости, измененной каким-либо предшествовавшим патологическим процессом, чаще всего деструктивным. Они бывают при доброкачественных и злокачественных новообразованиях кости, при остеодистрофии, фиброзной остеодисплазии, при метастазах в кость (рак молочной железы, легких, щитовидной железы). </p>",
"diagnostics": "<p>Диагноз перелома подтверждается по данным рентгенограммы тазобедренного сустава и бедренной кости. При развитии неполного перелома (трещины кости) рентгенограмма не позволяет увидеть какие-либо изменения. При этом рекомендовано проведение магнитно-резонансной томографии (МРТ). Если проведение МРТ противопоказано или невозможно в силу каких-либо сопутствующих заболеваний или состояния пациента, то назначается компьютерная томография (КТ).</p>",
"treatment": "<p>На сегодняшний день оперативное лечение — это основной метод терапии, позволяющий пациенту восстановиться за максимально короткий срок после получения травмы.</p>\r\n<p>Для внутрисуставных переломов такой способ лечения более приемлем, так как после операции, согласно статистике, сращивание костей происходит в 70% случаев. Операция противопоказана пациентам старческого возраста и имеющим определённые заболевания, наличие у них инфицированных ран.</p>\r\n<p>В сложных случаях, когда нет эффекта от консервативного лечения, а к оперативному вмешательству имеются противопоказания, применяются такие способы лечения:</p>\r\n<ul>\r\n<li>Остеосинтез;</li>\r\n<li>Вытяжение скелета;</li>\r\n<li>Эндопротезирование сустава.</li>\r\n</ul>\r\n<p>Способ остеосинтеза заключается в использовании специальных конструкций из металла для фиксации фрагментов кости, обеспечивающих их сращение. Этот метод лечения позволяет быстро добиться необходимой подвижности конечности пациента, как правило, спустя 6-10 недель.</p>\r\n<p>Вытяжение скелета используется, когда оперативное лечение невозможно по ряду причин. Осуществляется эта манипуляция при помощи шины Белера. Пациенту проводятся обезболивающие процедуры. Потом для вытяжения через большеберцовую кость продевается спица, закрепляемая на специальной скобе, к которой будет подвешен груз. Обычно груз весит 10 килограмм, но устанавливаемый вес зависит от тяжести повреждения и степени смещения. Больной укладывается на щит, а его конечность помещается на шину Белера. Вытяжением скелета занимаются до 12 недель, но иногда срок может сократиться вдвое. На повреждённую ногу накладывают повязку из гипса на срок около 5 месяцев. Недостатком такого лечения является долгое пребывание конечности в обездвиженном состоянии, что негативно сказывается на выполнении её основных функций в дальнейшем.</p>\r\n<p>Аппараты внешней фиксации признаны современной медициной ещё одним надёжным методом лечения при переломах. Показанием к их использованию служит имеющийся у пациента перелом бедра в области шейки.</p>\r\n<p>Своевременное тотальное эндопротезирование позволяет избежать серьёзных осложнений у пациента.</p>\r\n<p>При мыщелковых переломах бедра без смещения накладывают кокситную гипсовую повязку (от паха до лодыжек) на срок 4-8 недель. При смещении отломков перед наложением повязки выполняют их репозицию (сопоставление). </p>",
"prevention": "<p>Профилактика перелома бедренной кости состоит в проведении здорового и активного образа жизни, правильном питании, слежении за своим весом, своевременном обращении к врачу при первых симптомах болезней. Такого рода профилактика поддерживает здоровье в целом, укрепляет все системы в организме, включая костную систему.</p>",
"clinical_picture": "<p>Клиника переломов различных частей бедра протекает по-разному.</p>\r\n<p>Признаком перелома шейки бедра служат ощущения боли в тазобедренном суставе и области паха, которые становятся сильными при двигательной активности. Наблюдается некоторая деформация в тазобедренном суставе, небольшая отёчность повреждённого участка, отсутствие кровоподтёков.</p>\r\n<p>Если повреждение затрагивает вертельную область верхней части бедра, то симптомом её перелома является интенсивная боль, усиливающаяся при попытках движения травмированной ногой и ощупывания её. Для вертельного перелома характерны отёчность и кровоподтёки в области повреждения.</p>\r\n<p>Наиболее опасен чрезвертельный перелом. Его признаками являются выраженный отёк, боль и «симптом прилипшей пятки» (нельзя поднять прямую ногу вверх в положении лёжа).</p>\r\n<p>При переломе нижнего конца бедренной кости пациент предъявляет жалобы на резкую боль в колене и нижних отделах бедра. Движения в суставе ограничены и резко болезненны. Коленный сустав увеличен в объеме. Перелом наружного мыщелка сопровождается отклонением голени кнаружи. При переломе внутреннего мыщелка голень пациента отклоняется кнутри. </p>\r\n<p>Травма ноги со смещением считается более опасной, требующей долгого лечения. Для неё характерны следующие признаки:</p>\r\n<ul>\r\n<li>Деформация области травмированного участка сустава;</li>\r\n<li>Наличие резкой боли, возникающей при любом движении конечности;</li>\r\n<li>Появление отёка;</li>\r\n<li>Травмированная нога выглядит короче, чем здоровая;</li>\r\n<li>Кровоподтёки мягких тканей бедра;</li>\r\n<li>Повреждённая нога остаётся повёрнутой кнаружи на травмированной стороне.</li>\r\n</ul>\r\n<p>Перелом вколоченного вида признается по «симптому прилипшей пятки», постоянной боли в области таза, нарастающей по причине внутреннего кровоизлияния. Укорочение повреждённой ноги может не фиксироваться. Внутрисуставные разломы в покое проявляются слабой болью, но в движении она резко увеличивается.</p>",
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},
"code": "S72.0",
"name": "Перелом шейки бедра",
"icd_name": "Перелом шейки бедра",
"gender": 0,
"age_min": 30,
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"lead": "патологическое состояние, возникающее в ходе нарушения анатомической целостности бедренной кости в области шейки бедра",
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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Более чем в 90% случаев переломы шейки бедра возникают у людей, у которых уже присутствует остеопороз 2—3 степени. В таких ситуациях для получения травмы достаточно падения с высоты собственного роста. Поскольку в подобных случаях кости имеют низкую степень минерализации, а кровообращение обычно нарушено в силу развития других сопутствующих заболеваний, переломы срастаются очень плохо. Остеопороз – хроническое заболевание, сопровождающееся снижением минерализации костей, в результате чего они становятся более пористыми и хрупкими.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Также предрасполагают получению перелома шейки бедра у людей пожилого возраста: </span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">наличие онкологических заболеваний; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ведение малоподвижного образа жизни и патологии нервной системы, приводящие к ограничению подвижности или координации движений, в том числе болезнь Паркинсона, остаточные явления после инсульта; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ожирение; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">неправильное питание, голодание, приводящие к дефициту питательных веществ разных групп в организме; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">характерные для менопаузы гормональные изменения; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">атеросклероз и другие сосудистые патологии; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">снижение остроты зрения, что провоцирует повышение риска падения и получения травмы. </span></li>\r\n</ul>\r\n<p><span style=\"font-family: Verdana; font-size: 9.33333px; white-space: pre-wrap;\">В то же время у молодых людей перелом шейки бедра является редкостью, поскольку бедренные кости отличаются высокой прочностью и устойчивостью к воздействию различных травмирующих факторов. В таких ситуациях переломы обычно являются следствием: </span></p>\r\n<ul>\r\n<li><span style=\"font-family: Verdana; font-size: 9.33333px; white-space: pre-wrap;\">ДТП; </span></li>\r\n<li><span style=\"font-family: Verdana; font-size: 9.33333px; white-space: pre-wrap;\">производственной травмы; </span></li>\r\n<li><span style=\"font-family: Verdana; font-size: 9.33333px; white-space: pre-wrap;\">падений с большой высоты;</span></li>\r\n</ul>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Тазобедренный сустав – один из самых крупных суставов. Он выполняет опорную функцию и несет значительную нагрузку при беге и ходьбе. Сустав состоит из шаровидной головки бедра и глубокой округлой вертлужной впадины, окруженных капсулой и мощными связками. Еще одна крупная связка располагается прямо в центре сустава и соединяет дно вертлужной впадины с головкой бедра. В своей периферической части головка переходит в шейку, а шейка – в тело бедренной кости. Шейка расположена под углом к основной части кости, в области угла располагаются большой и малый вертелы.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Кровоснабжение головки осуществляется тремя путями. Первый – через сосуды, расположенные в капсуле сустава, второй – через артерии, проходящие внутри кости, и третий – через сосуд, расположенный внутри связки между головкой бедра и вертлужной впадиной. С возрастом кровоснабжение головки бедра ухудшается, сосуды сужаются, а артерия внутри связки полностью закрывается и перестает «работать». При переломах шейки проксимальный отломок лишается питания из внутрикостных сосудов. Артерий в капсуле оказывается недостаточно для адекватного снабжения кости кровью, поэтому проксимальный костный фрагмент не прирастает к дистальному, а в некоторых случаях и вовсе рассасывается. Такое состояние называется аваскулярным некрозом или остеонекрозом шейки и головки бедра.</span></p>",
"diagnostics": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагностический поиск осуществляется врачом-травматологом. Для подтверждения диагноза выполняют рентгенографию тазобедренного сустава. В сомнительных случаях осуществляют КТ тазобедренного сустава, МРТ тазобедренного сустава или сцинтиграфию. Поскольку при данной травме обычно показано оперативное лечение, пациенту назначают полное обследование для выявления соматической патологии, оценки анестезиологических и операционных рисков.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Консервативное лечение</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение данной патологии осуществляется в условиях травматологического отделения. Консервативную терапию проводят только в особых обстоятельствах – при наличии серьезных противопоказаний к хирургическому вмешательству (например, при недавно перенесенном инфаркте миокарда). В сомнительных случаях применяют индивидуальный подход, сравнивают риски длительного пребывания на постельном режиме (при консервативном лечении) и наркоза в сочетании с масштабной операцией (при оперативном лечении). Возможные варианты лечения:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Скелетное вытяжение. Накладывают достаточно активным больным молодого, среднего и пожилого возраста при противопоказаниях к оперативному лечению.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Деротационный сапожок. Является оптимальным вариантом при лечении пациентов старческого возраста (80-85 лет и старше), особенно при наличии старческого слабоумия и других психических отклонений. Эта методика, как правило, не обеспечивает сращения шейки бедра, но позволяет упростить уход за пациентом и дает возможность сохранить хотя бы минимальный уровень физической активности на тот период, пока в области перелома образуется соединительнотканная мозоль.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Хирургическое лечение</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Хирургическое вмешательство показано сохранным пациентам. Выбор метода оперативного лечения осуществляют с учетом возраста больного и уровня его физической активности до перелома. Активным больным младше 65 лет проводят репозицию и выполняют остеосинтез перелома с использованием различных металлоконструкций. Людям старше 65 лет, при условии, что они до травмы свободно передвигались и выходили на улицу, устанавливают двухполюсные эндопротезы. Пациентам старше 75 лет, которые до перелома ограниченно передвигались в пределах дома или квартиры, проводят однополюсное эндопротезирование цементным эндопротезом.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для остеосинтеза шейки бедра чаще используют три больших канюлированных (полых) винта. Вначале выполняют открытую репозицию, затем вводят в отломки несколько спиц, делают контрольную рентгенографию, выбирают наиболее удачно проведенные спицы и «надевают» на них винты, используя спицу как направитель. Реже для фиксации фрагментов применяют более массивные компрессионные винты, специальные пластины или трехлопастные гвозди.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В пожилом возрасте, когда увеличивается риск остеонекроза и несращения перелома, а также при значительном смещении отломков оптимальным вариантом становится эндопротезирование тазобедренного сустава. Двухполюсное эндопротезирование подразумевает замену не только шейки и головки бедренной кости, но и вертлужной впадины. Используются бесцементные протезы – специальные пористые конструкции, в которые в последующем прорастает кость. Иногда чашу, замещающую вертлужную впадину, дополнительно фиксируют винтами. Этот метод лучше подходит достаточно молодым пациентам – он обеспечивает надежную фиксацию и более удобен при последующей замене эндопротеза.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Оптимальным вариантом при переломе шейки бедра у пожилых, как правило, становится установка цементного эндопротеза – конструкции, которая не предполагает врастания костной ткани, а фиксируется к кости при помощи специального полимерного цемента. Использование данной методики позволяет обеспечить надежную быструю фиксацию эндопротеза даже при выраженном остеопорозе. Вместе с тем, вид эндопротеза определяется не только возрастом – всем пожилым больным протезы подбирают индивидуально, и при хорошем состоянии костей в преклонном возрасте в ряде случаев устанавливают бесцементные конструкции.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В послеоперационном периоде назначают анальгетики, проводят антибиотикотерапию. При необходимости для профилактики развития тромбоэмболических осложнений применяют антикоагулянты (фондапаринукс, варфарин, далтепарин натрия, эноксапарин натрия и т. д.). После нормализации состояния пациента назначают ЛФК и физиотерапию. В восстановительном периоде осуществляют реабилитационные мероприятия.</span></p>",
"prevention": "<p><span id=\"docs-internal-guid-b921429a-7fff-8569-4bca-72285f7a7f8b\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Профилактика заключается в предупреждении травматизма, раннем выявлении и лечении остопороза.</span></span></p>",
"clinical_picture": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При возникновении перелома шейки бедра пострадавшие могут столкнуться со следующими клиническими проявлениями: </span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">нарушения опорной функции ноги, сопровождающиеся невозможностью больного встать на поврежденную конечность и ходить, нарушением конфигурации тазобедренного сустава; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">незначительные боли в паховой области, возникающие при попытках пошевелить поврежденной ногой и проходящие в состоянии покоя; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">поворот поврежденной ноги наружу, что можно определить по развороту колена и стопы, с невозможностью повернуть ногу внутрь; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">боли при надавливании или постукивании по пятке при выпрямленной ноге; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">укорочение ноги (типично для варусных переломов шейки бедра), что не всегда можно заметить самостоятельно, поскольку величина укорочения незначительна; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">гематома в паховой области, чаще всего возникающая через пару дней после получения травмы в силу глубины расположения костных структур в бедре.</span></li>\r\n</ul>",
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"code": "S70",
"name": "Поверхностная травма области тазобедренного сустава и бедра",
"icd_name": "Поверхностная травма области тазобедренного сустава и бедра",
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"age_max": 100,
"cause": [
3
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"periodicity": 1,
"slug": "s70_poverhnostnaya_travma_oblasti_tazobedrennogo_sustava_i_bedra",
"lead": "",
"description": "",
"etiology": "",
"pathogenesis": "",
"diagnostics": "",
"treatment": "",
"prevention": "",
"clinical_picture": "",
"image": null,
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"standard_type": 3,
"danger": 1,
"published": 1,
"parent": null,
"block_rubric": 207,
"standards": [
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]
}
]
}
